The invention relates to medicaments for initiating ovulation.
It is known that ovulation is initiated physiologically by the release of LH, which takes place in the middle of the menstrual cycle and causes ovulation from ripe follicles; a release of FSH of smaller magnitude takes place simultaneously, probably acting synergistically with LH.
In treatment, it is preferable to provoke the initiation of ovulation for reasons of efficiency and programming even though spontaneous initiation of ovulation is always possible.
Chorionic gonadotropic hormone, or HCG, which extracted from the urine of pregnant women and has biological activity of the LH type, has been very widely used for this purpose since the 1930s.
Since then the initiation of ovulation during menstrual cycles stimulated by anti-oestrogens or HNG has been brought about by a single injection of 5000 or 10000 I.U. of HCG.
HCG nevertheless has its own specificity with respect to LH, giving rise to reactions which differ according to the receptors, and which give it a prolonged half-life in comparison with LH.
HCG has the advantage of being effective in initiating ovulation and having a low production cost.
But it has very major potential disadvantages. Apart from the need to have sufficient collected urine to extract marketable quantities of HCG, two major risks may arise, namely an ovarian hyperstimulation effect, which might occur to a greater or lesser extent when HCG is administered with exaggerated follicular stimulation, and multiple pregnancies, which are a coroliary of the complication. These two disadvantages significantly mar the use of HCG in treatment, and make it desirable to use LH for initiating ovulation.
The use of indigenous LH has been envisaged. With a few very rare exception, patients receiving ovulatory stimulation have a reserve of LH in the pituitary which can be mobilized through the use of GuRH itself, or one of its commercially available agonists. The administration of an agonist gives rise to a very major release of LH, which is wholly comparable with the pre-ovulatory physiological peak, but this release rarely lasts longer than 24 hours, whereas the physiological peak extends over about 48 hours.
This way of initiating ovulation with endogenous LH virtually eliminates the risk of ovarian hyperstimulation, as a result of the weaker biological activity of LH and its shorter half life in comparison with HCG. Its dilution half-life is in fact about 1 hours, and its elimination half life is about 24 hours, that is ten times shorter than that of HCG. Likewise it would seem that the risk of multiple pregnancies is smaller when this method is used.
Finally, the administration of a GnRH agonist also mobilises pituitary FSH synchronously with the release of LH, thus reproducing the physiological peak more faithfully.
However, the shortness of the period during which LH is released is this way is not appropriate for initiating ovulation in a number of woman. Every woman has in fact a specific LH peak profile and in general an increase in LH for more than 24 hours is necessary to initiate ovulation under satisfactory conditions. It follows that the initiation of ovulation by endogenous LH mobilized by a GnRH agonist can depend on a luteal phase of satisfactory quality, with satisfactory chances for conception, but also, a short luteal phase (lasting 8 days of less) or an inadequate luteal phase (of normal length but with progesteronaemia below 8 ng/ml).
In order to overcome these disadvantages it has been suggested that exogenous LH obtained from the human pituitary should be used. However, for obvious reasons of availability, it has not been possible to continue experiments with such a material for a long time. Obtaining LH in recombinant from has made it possible to continue with this type of experimentation, but given the half life of LH the initiation of ovulation by recombinant LH means that large doses have to be injected. Smaller doses are likely to give rise to a relatively brief LH plasma peak in comparison with the physiological peak, and are likely to give rise to the same problems as with enodgenous LH.
Injections then have to be repeated, which gives rise to the dual problem of acceptability by the patient and cost, as the production cost of recombinant LH is high.
The inventor""s work in this field has demonstrated that the problems mentioned above can be overcome by administering LH in the form of a medicament which brings about a release which reproduces the physiological peak of approximately 48 hours more faithfully.
The invention therefore relates to the provision of new forms for the administration of medicaments based on LH for initiating ovulation.
Medicaments for the initiation of ovulation according to invention are characterised in that they incorporate LH in an administrable form which ensures an increase in the plasma level of LH for approximately 40 to 60 hours.
The use of LH in such an administrable form gives rise to a satisfactory ovulation process.
Advantageously the LH may be used in association with FSH, by which means the physiological process can be reproduced more faithfully and the quantity of LH required to initiate ovulation can undoubtedly be reduced.
Appropriate proportions correspond to a LH to FSH ratio of approximately 5.
Endogenous forms of these hormones or their a xcex2 sub-units, or again recombinant forms of these hormones or their sub-units, such as are produced by genetic engineering, are used. It is also possible to use therapeutic analogues of LH of FSH, or peptide or non-peptide LH and FSH agonists, which may act over a long period. Compounds of this type may be produced by genetic engineering, or by synthesis, and are described for example by Boime et al., in xe2x80x9cin GnRH, GnRH analogs, gonadotropins and gonadal peptidesxe2x80x9d, F. Bouchard, A. Garaty, HJT Coeningh Bennink and SN Pavlov Eds, The Parthenon Publishing Group, London 1993, p. 347-356.
The administrable forms correspond to particles having a size of approximately 1 to 250 xcexc, see below.
In accordance with one embodiment of the invention these particles are based on a concentrate of LH and, if applicable, FSH.
Preferred particles of this type comprise lyophilisates, which may or may not be stabilized with source and/or salts of dicarboxylic acids.
In accordance with another embodiment of the invention, the particles comprise a solid envelope enclosing the LH, which may be associated with FSH and pharmaceutical excipients.
The envelope may then control the release of the active ingredient.
Appropriate materials for forming the envelope comprise biodegradable polymers. Among these polymers mention may be made of polylactic acid or a copolymer of lactic acid and glycolic acid.
In accordance with other embodiments the particles comprise a continuous matrix of the supporting material within which the active ingredient is dispersed.
These different forms are administered by injection or as a subcutaneous or intramuscular implant.
The dose of LH injected to obtain satisfactory ovulation in this form should be between approximately 10,000 and 25,000 I.U.
Toxicological investigations performed show that the medicaments according to the invention are harmless.
Other features and advantages of the invention are provided in the examples which follow: